Learning From Practitioners Serving LGBTQ+ Forced Migrants and Other Diverse Groups: Implications for Culturally Informed Affirmative Practice

Abstract

Objectives: This study explored the perspectives of mental health practitioners servingLGBTQ+ forced migrants, LGBTQ+ individuals, and forced migrants not identifying asLGBTQ+ to understand the clinical frameworks guiding their practice and how they approached clients whose identities were similar to or different than their own. Methods: Twenty-eight mental health practitioners from three Canadian cities participated in qualitative interviews. The sample comprised practitioners serving LGBTQ+ forced migrants (n=11); forced migrants not identifying as LGBTQ+ (n=9); and non-migrant LGBTQ+ clients (n=8). Thirteen providers identified as white; 3 as Middle-Eastern/North African, 3 as Latinx, 1 as West African, 1 as Indigenous, 1 as West Asian, and 1 as Other. Data were analyzed using constructivist grounded theory. Results: Practitioners across all three 3 sample groups used similar approaches, whether or not they worked with clients whose sexual orientations, gender identities, racial/ethnic backgrounds, or migration status were different than their own. Practitioners described using an eclectic approach, incorporating cultural competence, cultural humility, and LGBTQ+affirmative and anti-oppressive practices in their work. Practitioners also noted that lack of training for ancillary providers could lead to discrimination that negatively impacts clients, making establishing a therapeutic relationship challenging. Conclusions: Findings suggest that the concepts of cultural humility, cultural competence, and affirmative practice may not be mutually exclusive. The similarities in practice approaches across provider samples point to the salience of integrating these clinical practice concepts and frameworks when working withLGBTQ+ forced migrants, LGBTQ+ individuals with diverse cultural backgrounds, and forced migrants who do not identity as LGBTQ+.

“If You Can Just Break the Stigma Around It”: LGBTQI+ Migrants’ Experiences of Stigma and Mental Health

“…This finding is consistent with work by Kirmayer et al (2011) who call for a systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational, and family functioning over time. Our findings support clinical care recommendations that caution reducing client’s identities to SOGIE only, and to consider multiple factors shaping their mental health (Alessi et al, 2021; Veale et al, 2015). While many countries have adopted human rights and humanitarian laws protecting LGBTQI+ migrants, the experience of compounded trauma and stress exists based on multiple forms of stigma such as homophobia, transphobia, across migratory experiences (Alessi et al, 2020, 2021; FoxGriffin et al, 2020; James et al, 2018; Lee et al, 2022).…”

“…Our findings support clinical care recommendations that caution reducing client’s identities to SOGIE only, and to consider multiple factors shaping their mental health (Alessi et al, 2021; Veale et al, 2015). While many countries have adopted human rights and humanitarian laws protecting LGBTQI+ migrants, the experience of compounded trauma and stress exists based on multiple forms of stigma such as homophobia, transphobia, across migratory experiences (Alessi et al, 2020, 2021; FoxGriffin et al, 2020; James et al, 2018; Lee et al, 2022).…”

“…It is well documented that LGBTQI+ people experience poorer mental health status when compared with heterosexual and cisgender people (Mustanski et al, 2010; Rotondi et al, 2011). For LGBTQI+ migrants, mental health concerns are exacerbated by structural stressors which include healthcare access and quality of care (Alessi, et al, 2021). Mental health is more than the absence of disease and includes intersecting determinants of health such as stigma and other intersecting social dimensions of health (James et al, 2018; Salam et al, 2022; Salami et al, 2019).…”

“…Disclosure of SOGIE during the IRB process may also elicit fears related to deportation (James et al, 2018; Logie, Lys, et al, 2019; Munro et al, 2013). These experiences are particularly challenging for migrants who also identify as trans and nonbinary people (Alessi et al, 2021; Cerezo et al, 2014; Lee et al, 2022; Sansfaçon et al, 2018).…”

“…Post migration, contextual and structural factors continue to shape LGBTQI+ migrants’ experience of stigma, discrimination, and marginality, which may heighten the risk of stress, and poorer mental health. Historically, LGBTQI+ people have faced homophobia and transphobia from healthcare professionals and this legacy continues to play out as microaggressions from health care professionals in the form of rejection (Alessi et al, 2021; Drescher, 2015; Hudson & Romanelli, 2019; Veale et al, 2015). Microaggressions are intentional/unintentional and verbal/nonverbal acts that target a group based on their marginality, and can be retraumatizing (Sue, 2010).…”